Obama Official in San Antonio Touts Health Care Subsidies

Secretary for Health and Human Services Sylvia Burwell speaks at the Enroll SA event at New Creation Christian Fellowship Church, a non-denominational church in Windcrest. Photo by Iris Dimmick.

Updated October 7, 2016

Eyole Mbongo became the public face Monday for 77,000 Bexar County residents who changed their status from no health insurance to full coverage in 2014.

Speaking at a Monday news conference to promote the second round of enrollment for the Health Insurance Marketplace as part of the Affordable Care Act, Mbongo displayed obvious relief in being able to afford health insurance for the first time in several years.

“I now know that if something happens to me and I go into a hospital and clinic and the first question they might ask is do you have insurance, that I can say yes and not worry that I cannot afford the expense of the treatment,” Mbongo said.

A full-time graduate student in public administration at The University of Texas at San Antonio, Mbongo also works part-time. But his paycheck didn’t cover the cost of private insurance. Through the Health Care Marketplace, he obtained a full coverage Humana plan with a $150 monthly premium that shrunk to 3 cents after federal subsidies. His only out-of-pocket expense when he sees a doctor is a modest co-pay.

Eyole Mbongo, a UTSA grad student studying Public Administration, speaks at the Enroll SA event at New Creation Christian Fellowship Church, a non-denominational church in Windcrest. Photo by Iris Dimmick.

“When I was signing up for the plan, I wasn’t expecting to see anything as low as three cents out-of-pocket. I was amazed that something like that existed,” he said.

Mbongo signed up for a flu shot for the first time in six years because it was free under his plan.

“I think having this insurance is allowing me to think about doing more preventive care rather than just praying I don’t get sick and then figuring out what to do then.”

It turns out his case is not that unusual. Secretary for Health and Human Services Sylvia Burwell, whose appearance at Monday’s news conference is part of a national tour to talk up marketplace successes, reported that of those who signed up during the first enrollment period this year, 7 out of 10 had premiums under $100. Nationwide, 65% of applicants qualified for subsidies, she said. In Texas, 84% of Texans got financial help, according to the Center for Public Policy Priorities in Austin.

“We as a people have a moral obligation to see that everybody has access to quality and affordable health insurance,” said Mayor Ivy Taylor who joined Burwell at the news conference. “A community prospers when its citizens are healthy.”

Burwell urged people without insurance to visit HealthCare.gov, choose the best plan among many options, and sign up by Dec. 15 to have coverage starting Jan. 1. Enrollment for 2015 will remain open until Feb. 15.

To those who signed up last time, Burwell emphasized that even if they are happy with the plan they already have, they need to re-enroll. About 90% of the information entered last time will appear on the form so people don’t have to re-enter it. Burwell said it’s important to make sure the information remains accurate and that the plan individuals previously chose is still the best one to meet their needs; 25% more plans were added this time.

The Health Insurance Marketplace enrolled 734,000 Texans in 2014. Bexar County accounted for 77,000 of those newly insured, a number that far exceeded the goal of 46,000, which remains the goal for the current enrollment period. Bexar County Judge Nelson Wolff, in attendance on Monday, has helped lead this effort, but in Bexar County, 27% of the population remains uninsured. Of those, 75% identify themselves as Hispanic, according to Andrea Guajardo, speaking for Enroll SA, a coalition of 40 organizations and 176 trained volunteers in Bexar County trained to help people sign up for insurance.

Director of Community Health at Christus Santa Rosa Health System Andrea Guajardo speaks at the Enroll SA event. Photo by Iris Dimmick.

Asked about HHS’s outreach to Hispanic uninsured residents, Burwell pointed to several initiatives.

Spanish language call service. “In the early days of enrollment, out of 200,000 calls to our call center, 20,000 were using our Spanish-speaking call service.”Burwell said.

Spanish language equivalent of HealthCare.gov: CuidadodeSalud.gov.

Increased the number of Spanish speakers providing in-person assistance to help with online sign-up.

Improved interface for mobile users. “The Latino population has a deeper penetration of mobile use than the population as a whole.”

“One of the things we learned from the initial enrollment was the importance of trusted voices,” Burwell said. “I’ve had a chance today to talk with the leadership of the community and the stakeholders about their work and to hear their feedback, so we can make things better.”

One challenge Burwell and other Obama administration officials face comes from Texas and other red states where governors and other officeholders oppose the Affordable Care Act. That raises concerns about the reliability of the subsidy program.

The U.S. Supreme Court has agreed to hear a case challenging the legality of subsidies in states like Texas where there is no state health insurance exchange (Texans use the federal exchange). Burwell advises people to sign up for insurance and get the subsidies they can.

“We believe that we hold the right position,” she said. “The U.S. Congress did not intend that some states would benefit from financial assistance and others would not.”

U.S. Rep. Joaquín Castro, who also attended the event, said, “Many of us were disappointed when two years ago, the Texas Legislature refused to expand Medicaid in Texas. That hurt Texans and our many hospitals that provide millions of dollars every year in uncompensated care. We should be ready to pressure the Legislature in the best way possible to expand Medicaid in Texas in 2015.”

Another challenge will be the technical performance of the government’s website. To prevent the computer problems that plagued the initial sign-up period, Burwell said the website was tested for five weeks before opening it to the public (up from 10 days before the first rollout). Officials also simplified the application for first-time users and made it more intuitive. Applicants must now work through 16 instead of 76 screens in completing the form.

For 26 years, Karen Stamm wrote stories about discoveries in biomedical research and advances in health care for The University of Texas Health Science Center at San Antonio. Now she spends most of her time tending gardens. She gave up nurturing the struggling grass on her suburban lot and replaced it with native and adapted plants. She is an active member of Gardening Volunteers of South Texas and Northwest Hills United Methodist Church.